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NPI Code Detail

MEDICARE: PURA E MEDINA APRN

MEDICARE: PURA E MEDINA APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner9305335FL

General Provider Information

NPI Number : 1316473614
Entity Type Code : Individual
Provider Name (Legal Business Name) : PURA E MEDINA APRN
Provider Business Mailing Address
First Line : 2924 W 68TH PL
Second Line :
City : HIALEAH
State : FL
Zip : 33018-5362
Country : US
Telephone Number : 786-991-8143
Fax Number :
Provider Business Practice Location Address
First Line : 1400 NE MIAMI GARDENS DR STE 105
Second Line :
City : NORTH MIAMI BEACH
State : FL
Zip : 33179-4843
Country : US
Telephone Number : 786-610-3730
Fax Number : 786-610-3919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2017
Last Update Date : 10/31/2024

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Directions to “ PURA E MEDINA APRN” Practice Location

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